Where does the smell come from?
Bacteria live in the mouth, which break down protein residues and release volatile sulfur compounds with a characteristic rotten odor. Most of these bacteria accumulate on the back third of the back of the tongue, where the uneven relief of the papillae retains plaque, as well as in deep gum pockets and under the overhanging edges of fillings and crowns. Saliva naturally washes away these substances and inhibits bacterial growth, so any condition that reduces saliva production increases odor—hence morning odor after sleep and odor when dehydrated.
- Plaque on the back of the tongue is the main source
- Gum pockets due to periodontitis
- Cavities and food debris
- Overhanging edges of fillings and crowns
- Dry mouth and decreased salivation
- Removable dentures without proper care
Causes outside the mouth
In approximately one in ten patients, the source is located outside the mouth. Most often these are ENT organs: chronic tonsillitis with plugs in the tonsils, sinusitis with postnasal drip, adenoids in children. Stomach diseases cause odor less often than is commonly thought, and are usually accompanied by heartburn, belching and other complaints. There are also specific odors: sweetish fruity is a sign of ketoacidosis in diabetes and requires emergency care, ammonia is a sign of severe renal failure. In children, a one-sided putrid odor from the nose forces them to look for a foreign body.
- Chronic tonsillitis and tonsil plugs
- Sinusitis and postnasal drip
- Adenoids and mouth breathing in children
- Gastroesophageal reflux
- Bronchiectasis and chronic lung diseases
- Diabetic ketoacidosis, renal and liver failure
- Foreign body in a child's nose
What gives a temporary smell
Not all bad breath is a disease. Almost everyone has it in the morning: at night little saliva is secreted, and bacteria multiply freely. Onions, garlic, and some spices contain compounds that are absorbed into the blood and excreted by the lungs, so brushing your teeth does not help them and the smell lasts for several hours. Fasting, strict low-carbohydrate diets, and long periods of not eating lead to the formation of ketones, which have a characteristic acetone hue. Alcohol and smoking give off their own persistent odor and at the same time dry out the mucous membranes.
- Morning smell after sleep
- Onions, garlic, spices
- Fasting and low carb diets
- Smoking and alcohol
- Dehydration and low fluid intake
- Taking medications that cause dry mouth
How to understand if there is a smell and what to examine
It is almost impossible to evaluate your own smell: the sense of smell quickly adapts. A simple home remedy is to lick a clean wrist, let the saliva dry for half a minute and smell it, or scrape the coating off the back of your tongue with a teaspoon. It’s safer to ask a loved one. At the appointment, the doctor examines the teeth, gums, tongue and dentures, assesses the depth of the gum pockets and takes an X-ray if hidden caries or inflammation at the root is suspected. If there are no findings in the mouth, the patient is referred to an otolaryngologist, and if there are complaints about digestion, to a gastroenterologist.
- Examination of teeth, gums and tongue
- Assessment of gum pockets and hygiene level
- Dental X-ray
- Examination by an ENT doctor: tonsils, nose, nasopharynx
- Examination of the stomach for heartburn and belching
- Blood glucose for thirst and weight loss
How to get rid of odor
Chewing gum and mouthwash mask the problem for 20–30 minutes and do not solve it. Something else works: professional hygiene with the removal of tartar, treatment of caries and gum diseases, daily brushing of the tongue with a scraper and the mandatory use of dental floss or brushes, because it is between the teeth that the most plaque remains. It is important to drink enough water and stimulate salivation, and quit smoking. Alcohol-containing rinses, when used frequently, increase dryness and ultimately worsen the situation.
- Professional hygiene and tartar removal
- Treatment of caries, periodontitis, replacement of defective fillings
- Cleaning your tongue daily with a tongue scraper
- Floss or interdental brushes every day
- Drinking enough, quitting smoking
- Care of removable dentures, removal at night
- Treatment of chronic tonsillitis and sinusitis